摘要【目的】探讨高强度聚焦超声(HIFU)联合促性腺激素释放激素激动剂(GnRH-a)及左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌瘤的临床疗效。【方法】回顾性分析2019年10月至2021年11月在湖北省十堰市太和医院住院治疗的201例子宫腺肌瘤患者的临床资料,根据治疗方案不同分为单纯HIFU组(A组,n=62)、HIFU联合LNG-IUS组(B组,n=68)、HIFU联合GnRH-a及LNG-IUS组(C组,n=71)。比较三组患者治疗前和治疗后第1天病灶的消融率,比较三组治疗前与治疗后1个月、3个月、6个月、12个月子宫体积、痛经视觉模拟评分(VAS)及血红蛋白、糖类蛋白125(CA125)水平。【结果】三组患者消融率比较,差异无统计学意义(P>0.05)。治疗后1个月、3个月、6个月、12 个月,三组患者子宫体积、痛经 VAS 评分及CA125水平均低于治疗前,血红蛋白水平高于治疗前,差异有统计学意义(P<0.05)。治疗后6个月、12个月,C组患者子宫体积、痛经VAS评分及CA125水平均显著低于A组、B组,C组血红蛋白水平均高于A组、B组,但A组和B组上述指标比较,差异无统计学意义(P>0.05)。【结论】单纯HIFU、HIFU联合LNG-IUS、HIFU联合GnRH-a及LNG-IUS治疗子宫腺肌瘤均安全有效,但HIFU联合GnRH-a及LNG-IUS在缩小子宫体积、缓解痛经及改善贫血等相关症状的疗效更佳,且复发率也低于其他两种方法,值得临床推广应用。
Abstract：【Objective】To explore the clinical efficacy of high intensity focused ultrasound (HIFU) combined with Ganodotropin releasing hormone agonist (GnRH-a)and levonorgestrel releasing intrauterine system(LNG-IUS) in the treatment of uterine adenomyoma. 【Methods】In this study,201 patients with adenomyoma of uterus who were hospitalized in Taihe Hospital of Shiyan city from October 2019 to November 2021 were selected and divided into three groups:HIFU alone group (Group A,n=62),HIFU combined with LNG-IUS group (Group B,n=68) and HIFU combined with GnRH-a and LNG-IUS group (Group C,n=71).The ablation rates of lesions on MRI before treatment and on the first day after treatment were compared in the three groups. Levels of uterine volume,hemoglobin,visual analogue scale (VAS) and CA125 were compared before treatment and 1,3,6,12 months after treatment. 【Results】There were no significant differences in the ablation rates among the three groups (P>0.05). After 1,3,6 and 12 months of treatment,the uterine volume,dysmenorrhea VAS score,and CA125 level in all three groups were lower than those before treatment,while the hemoglobin value was higher than that before treatment. After 6 and 12 months of treatment,the uterine volume,dysmenorrhea VAS score and CA125 level in Group C were significantly lower than those in Group A and B (P<0.05),but there was no significant difference between Group A and group B (P>0.05). The hemoglobin value of Group C was higher than that of Group A and group B after treatment (P<0.05),however,there was no significant difference between Group A and group B (P >0.05). 【Conclusion】HIFU alone,HIFU combined with LNG-IUS and HIFU combined with GnRH-a and LNG-IUS are all safe and effective in the treatment of uterine adenomyoma. However,the therapeutic effect of HIFU combined with both GnRH-a and LNG-IUS is much better than that of HIFU alone and HIFU combined with LNG-IUS,while its recurrence rate was lower than that of HIFU alone and HIFU combined with LNG-IUS.
李肖肖, 张逸群, 陈锦云, 方彩云. 高强度聚焦超声联合GnRH-a及LNG-IUS治疗子宫腺肌瘤的临床疗效[J]. 医学临床研究, 2023, 40(2): 168-172.
LI Xiao-xiao, ZHANG Yi-qun, CHEN Jin-yun,et al. Efficacy of High Intensity Focused Ultrasound Combined with GnRH-a and LNG-IUS in the Treatment of Adenomyoma. JOURNAL OF CLINICAL RESEARCH, 2023, 40(2): 168-172.
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2023, Vol. 40 
